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;. ~ <br />s ~r - <br />- - _- - -- <br />- --- -- _ - <br />--- -- - ` 03/18/2009~rrY) <br />'~ ACORDTM CERTIFICATE OF LIABILITY INSURANCE - -'~` - _ <br />- --- - - - - <br />-- ---- ---- <br />_ _ <br />--_ - - <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF <br />Marsh Risk & Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />4695 MacArthur Court, Suite 700 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />' (949) 399-5800 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />License #0437153 <br />Newport Beach, CA 92660 <br />.607996-002-002-08-09 <br />- - - - - <br />INSURED <br />Westcliff Medical Labs, Inc. <br />Attn: Rodney Brown <br />1821 E. Dyer Road, Suite 100 <br />Santa Ana, CA 92705 <br />IH`If ~ ~ ~ 1' <br />CITY 0% _ '~~~ A~ <br />CLERK yr ,.,~J~1C! <br />INSURERS AFFORDING COVERAGE <br />_- - -- -_- <br />- -_ .. <br />~uRER A Travelers Property Casualty Co. Of America <br />- -- - <br />ERB United States Fire Insurance Co. <br />~ - - - <br />w RERC Nautilus Insurance Company <br />INSURER D: <br />INSURER E <br />NAIC # <br />25674.,._ -- <br />21113 <br />,17370 _-- <br />-~- - -- <br />_ _ ---- - <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />COVERAGES NY RE UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />NOTWITHSTANDING A Q <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br />CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ _ _- <br />- --- <br />-------__-- - ~- -- -- ~«~:-rivo enr Irv cvoio ennw <br />INS quv y TYPE OF INSURANCE ' <br />INSR POLICY NUMBER 'DATE (MMlDDlYY) DATE (MM/DDlYY) ~ "'~" ~ ~ I <br />GENERAL LIABILITY <br /> <br />~ - 630 154D589A-TIL-08 <br />q EACH OCCURRENCE <br />-{ - - <br />10!01/08 10/01/09 ~ ~AnnACE ro RENrEO $ - 1.~000~Q~ <br />- <br />00 <br />100 <br />I <br />i X '', COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence , <br />' - i ~--- <br />X <br />- 1 MED EXPfAny one person) ~ <br />-_ S,OOa <br />_ _ --_J <br />_ OCCUR <br />CLAIMS ngp.DE <br />'~ _ --- - ~ <br />' I PERSONAL & AD'v INJURY i$ I ,000,OOO <br />- <br />T <br /> <br />_- <br />ERAL AGGREGATE LIMIT APPLIES PER <br />G E j PRODUCTSGCOMP/OP AG $ <br /> <br /> <br />- - - -- <br />~ _ 2 OOO,OOO <br />PRO- <br />'. ~ POLICY i ~ JECT ~ LOCI ~ <br />OMOBILE uABIUTY <br />' <br />,ALIT 810 154D589A-TIL-08 ~ 10!01/08 110/01/09 <br />SwGLE LIMIT I <br />D <br />o <br />O $ 00 <br />1 <br />000 <br />A t <br />i E <br />cide <br />a a , <br />, <br /> <br />X ', ANY AUTO <br />~ t <br />_ <br /> <br />~ <br />- - <br />i <br />~ BODILY INJURY <br />~ $ <br />~ ~ <br />~I <br />p <br />I ~ H RED AUTOS UTOS !-~ <br />C'~~i'~~lJ Y ~ll tea 1 it <br />i ~~1V1 <br />LY NJURY ---- <br />ODI <br />~ ~ -- <br />- _ ~~ <br />-- -- - <br /> <br />NON-OWNED AUTOS ~ <br />~ .. <br />- ~ <br />~~~ /~ %~ <br />(Per accident) <br />~'. PROPERTY DAMAGE <br />' <br /> <br />$ , <br /> <br />- <br />. <br />r_ (: ~ ~- ~~ <br />~ IPer accident) <br />~ i <br />!, GARAGE UABILITV <br />~:ity F,t u~r~~ ~~ <br />istant <br />~ !AUTO ONLY - EA ACCIDENT <br />~ - - - $ <br />- <br />- - <br />-- <br />~'I ANY AUTO . <br />ss OTHER THAN _EA ACC <br /> <br />AUTO ONLY: $ <br />- - <br />$ <br />-_ - -----~. <br />~i <br />I AGG <br />~ <br />EXCESS/UMBREUIILIABILITY <br />!CUP 154D589A-TIL-OS I 10/01/08 EACH OCCURRENCE <br />lO/O1/O9 $ 2,000,00 <br />O <br />OO <br />1 CLAIMS MADE <br />k ] OCCUR <br />~ AGGREGATE $ , <br />q <br />2 OO <br />_ <br />.. <br />I DEDUCTIBLE _ '~$ - <br />'~.. RETENTION $ <br />WORKERS COMPENSATION AND ' X I WC STATU- OTH- <br />ER- <br />'TOI3YlIMfr_s <br />~ <br />- <br />- <br />EMPLOYERSUABIUTY <br />B i <br />ORlPARTNERlEXECUTIVE 408696715-8 !, 12/01/08 i 12/01!09 - <br />L <br />,EACH ACCIDENT - <br />I $ <br />$ - -- <br />1 OOO,OOQi <br />ANY PROPRIET <br />OFFICER/MEMBER EXCLUDED? .DISEASE - EA EMPLOYE <br />-. 1 OOO,OOQ <br />- - <br />If yes, describe under <br />i ! L. DISEASE -POLICY LIMIT $ 1 ,000,00 <br />SPECIAL PROVISIONS below <br />I <br />~ <br />~I OTHER <br />i <br /> <br />~ <br /> <br /> <br />II C professional <br />PFP1000006P2 ~ <br />10101!08 h Ciaim <br />10/U1/09 Eac 2 OOO,Ovu <br /> <br />' <br /> Aggregate Limit 4,00 <br />~ Liability <br />~ <br />I i <br />Deductible 5 000 <br />, Retro Date: 8!31/09 <br />DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCUJSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />10 Day Notice of Cancellation for Non-Payment of Premium. The City of Santa Ana, it's officers, agents and employees are included as Addition al Insured as <br />required by written contract. <br />- - -- <br />CERTIFICATE HOLDER LOS-000684416-15 <br />CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />City of Santa Ana EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />20 Civic Center Plaza (M-29) 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />PO Box 1988 <br />BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND <br />oanw nna, vn acr vc <br />iL <br />ACORD 25 (2001 /08) <br />O ACORD CORPORATION 1 S88 <br />